Provider Demographics
NPI:1033876867
Name:KUBIK, ANNE THERESE (LADC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:THERESE
Last Name:KUBIK
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:THERESE
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:1404 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1517
Mailing Address - Country:US
Mailing Address - Phone:612-235-7378
Mailing Address - Fax:
Practice Address - Street 1:1404 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1517
Practice Address - Country:US
Practice Address - Phone:612-235-7378
Practice Address - Fax:612-789-8087
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)